Abstract
Author(s): Nadia Kamile Al-Mashta, Karar Nadhm Obaid Aljabry, Alaa Abdul Razzaq AL- NUAIMI, Saif M. Hassan*
Background: Various biochemical markers levels rise with postmenopausal Hormone Replacement Treatment (HRT). Inflammatory indicators like CRP promote cardiovascular problems. However, the therapeutic ramifications of HRT-induced CRP alterations are unclear. Methods: A study was conducted between January 2000 and February 2023 to investigate the association between inflammatory markers, thrombosis, and coronary heart disease. The study cohort comprised 608 individuals who were free of cardiovascular disease and cancer at the time of baseline assessment. Participants were surveyed on their utilization of hormone therapy, which was categorized into three groups: 'non-user,' 'E' (estrogen-only therapy), and 'EP' (estrogenprogestin therapy). Further subgroup analyses were conducted within these categories. Results: In the study, 83% of women on E had undergone hysterectomy, with a median duration of estrogen use of 16.5 years. This is in comparison to the shorter duration of estrogen use for EP users, 96% of whom had undergone hysterectomies. The number of estrogen use cases (140) nearly doubled those of EP (70). Furthermore, a higher prevalence of diabetes history was observed in non-PHT users (12%) compared to E (3.7%) and EP users (2.8%). Finally, non-users exhibited a higher incidence of coronary events (56.5%) compared to E (45.5%) and EP users (45.1%). CRP levels were significantly higher in PHT users, especially female E users, even after adjustments. E users showed a significant decrease in tPA-antigen (p < 0.05), while IL-6 and sICAM-1 were reduced in EP users but not E users, though these differences disappeared in multivariate models. D-dimer levels remained the same. HDL and triglyceride levels were higher in PHT users, particularly E users, while LDL levels were lower in E users. Conclusion: The study revealed significant differences in biomarkers between CEE users and non-users. CEE users exhibited lower sICAM-1 and higher tPA-antigen, homocysteine, and HDL levels, while IL-6, sICAM-1, D-dimer, total cholesterol, and LDL levels remained unchanged. Of particular interest was the observation that sICAM-1 levels were markedly lower in CEE users who also used P, contrasting with the higher levels seen in CEE-alone and non-CEE EP users.